Medication Summary

Although no effective treatment is available, immunosuppressive therapies are frequently used.
[20] Immunosuppressive medications include corticosteroids, cyclophosphamide, and intravenous immunoglobulin (IVIG). Recent trials have included rituximab as a treatment for this condition.
[21] Anticonvulsants are used for seizure prophylaxis.

Immunomodulators

Class Summary

Has immunosuppressive properties. Chemically related to nitrogen mustards. As alkylating agent, mechanism of action of active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells.

PO/IV daily dosage recommendations have not been formulated for treatment of PEM. Modify dose based on clinical response or degree of leukopenia.

To avoid need to perform molecular weight-based adjustments when converting between fosphenytoin and phenytoin sodium doses, express dose as phenytoin sodium equivalents (PE). Although can be administered IV and IM, IV route is route of choice and should be used in emergency situations.

Concomitant administration of an IV benzodiazepine usually necessary to control status epilepticus. Full antiepileptic effect of phenytoin, whether given as fosphenytoin or parenteral phenytoin, is not immediate.